A case of aortic and mitral valve replacement in a patient who recovered from heart failure after an operation using left ventricular pacing, and who showed marked improvement of left ventricular contractile function and reverse remodeling

A 75-year-old male underwent double valve replacement (DVR) for severe aortic regurgitation (AR) and secondary mitral regurgitation (MR), in the presence of marked contractile dysfunction and left ventricular dilatation. He had complete atrioventricular(AV) block during the operation, and was unable to recover from low output heart failure with right ventricular pacing. However, using left ventricular (LV) pacing, he quickly recovered and after six months, marked improvement of LV contractile function [LV ejection fraction(LVEF) 35 → 65%] and reverse remodeling(LV end systolic diameter (LVDs) 68 → 46mm) was obtained. Early valve replacement has been recommended for regurgitation before irreversible myocardial dysfunction is able to occur due to volume overload. LVEF and LV diameters have been used as useful indexes for the timing of the operation. From the point of view of these previous indexes, this case might be thought to have had irreversible myocardial damage, but tremendous reverse remodeling was shown and sufficient cardiac function equal to normal performance was obtained after DVR. This clinical course has led us to reconsider the appropriate timing of valve replacement for regurgitation.